Radiologists want nuance in how CMS calculates physician practices’ administrative and overhead costs
Imaging groups want the Centers for Medicare & Medicaid Services to use more nuance when calculating radiology practices’ administrative and overhead costs.
CMS recently contracted with research outfit the RAND Corp. to investigate how the agency handles this task. The American College of Radiology and other advocacy organizations recently said such updates are sorely needed. Previous data (collected back in 2007 and 2008) underrepresented office-based physicians, and that’s led to some “dramatic undercalculation” of practice expenses, the groups said in comments submitted to RAND on June 23.
“We believe the most important component of producing accurate results relevant to the Medicare Physician Fee Schedule is gathering data that is diverse and representative,” wrote ACR, the American Society of Neuroradiology, and the Society of Nuclear Medicine & Molecular Imaging. “Regardless of the mechanism chosen to update indirect expenses, there needs to be an understanding that poor quality data will be excluded, preferably with preapproved statistical guardrails, and that stakeholder input will be valued and considered if irregularities arise,” they added later.
CMS last gathered this data more than a decade ago through the Physician Practice Information Survey. About 67% of radiologists contributing to the survey practice solely in hospital and academic settings, with no direct and only modest indirect costs compared to office-based practices. This has led to “too many” groups failing to cover all the expense categories used to set the expense rates, ACR et al. noted.
They also expressed concerns CMS previously gathered data from radiologists themselves, rather than practices. This led to physicians opting out due to the complexity of the survey. In many groups, docs are not involved in this detailed level of accounting, they noted.
“Like many specialties, radiology has seen consolidation of small group practices into large corporate, academic and privately held groups,” they wrote. “The day-to-day cost management has shifted further from the individual radiologist to the radiology business managers. This shift may improve the accuracy of data as organizations have the scale to develop more sophisticated cost accounting, assuming the correct stakeholders are surveyed.”
ACR said it plans to remain engaged with CMS. throughout the process. You can read the full letter to RAND Corp. here, and find a summary from the college shared June 24 here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.